[A Case of Carcinomatosis of the Bone Marrow Due to Rectal Cancer].

A 33-year-old man was admitted due to dyschezia and melena. Colonoscopy revealed a circulating type 4 rectal tumor. Further examination revealed intestinal obstruction due to rectal cancer, paraaortic lymph node metastasis, and multiple bone metastases, and an ileus tube was transanally inserted for decompression. Bone scintigraphy revealed multiple abnormal uptake regions in the entire skeleton. We planned to perform primary tumor resection and postoperative adjuvant chemotherapy and radiotherapy administration. Peritoneal signs in the lower abdomen appeared after 6 days of tube insertion. Abdominal computed tomography demonstrated intestinal perforation, and emergency surgery was performed. During the surgery, tube penetration in the anterior abdominal wall was observed in the sigmoid colon proximal to the tumor. Postoperatively, the patient developed disseminated intravascular coagulation(DIC). The patient had multiple bone metastases and juvenile cells in peripheral blood figure analysis; therefore, we concluded that DIC was caused by carcinomatosis of the bone marrow. After an informed consent was obtained, FOLFOX4 with simultaneous DIC treatment was initiated, and DIC remission was observed. The patient was transferred to a different hospital near his home, but died 35 days postoperatively.

[A Case of Sinusoidal Obstruction Syndrome and Nodular Regenerative Hyperplasia after Using Oxaliplatin for Rectal Cancer].

We present a case of a 44-year-old woman with rectal cancer(cT2N3M0, cStage Ⅲb)treated with 4 capecitabine-oxaliplatin( CAPOX)therapy courses, followed by laparoscopic intersphincteric resection. The patient received 7 postoperative, adjuvant CAPOX therapy courses. After 16 months since the final CAPOX administration, computed tomography(CT) revealed multiple liver tumors, showing early enhancement, and a jejunal mesenteric mass suspected to be a gastrointestinal stromal tumor(GIST). To overcome the percutaneous needle biopsy limitation, laparoscopic partial hepatectomy and laparoscopic- assisted partial intestinal resection were performed. Two liver lesions were diagnosed as nodular regenerative hyperplasia( NRH)with sinusoidal obstruction syndrome(SOS), supported by the hyperplasia and sinusoidal dilatation pathological findings, consequential to using oxaliplatin. Considering the rarity of NRH, using oxaliplatin may be proven vital in the differential diagnosis.

[Successful Control of Hyperammonemia with BRTO of a Splenorenal Shunt Induced by CAPOX Therapy].

Among portosystemic shunts, splenorenal shunts can cause increased portal pressure, which in turn can bring about hyperammonemia, resulting in hepatic encephalopathy. In recent years, it has been reported that oxaliplatin(OX), a key chemotherapy drug in colorectal cancer, can precipitate splenorenal shunts due to sinusoidal injury. We report a case of hyperammonemia post oxaliplatin therapy. A 72-year-old male patient who had undergone surgical resection for(RS)rectal cancer with hepatic metastasis had been receiving capecitabine plus OX(CAPOX)as adjuvant chemotherapy. During his 7th course of treatment, he visited the outpatient clinic with complaints of weakness, dysarthria, and urinary incontinence. Laboratory findings showed an elevated NH3 level (200 µg/dL), and subsequent abdominal computed tomography revealed a splenorenal shunt, which was attributed to OX. Balloon-occluded retrograde transvenous obliteration(BRTO)was then performed. The patient has been routinely followed up in the outpatient clinic and has had no recurrence of hyperammonemia or cancer 14 months after the procedure. In retrospect, the splenorenal shunt was present on his first visit, therefore, hyperammonemia could have been prevented at the time of commencement of chemotherapy. We report our case, along with the relevant literature.

Successful treatment with conversion surgery following chemoradiotherapy for unresectable invasive intraductal papillary mucinous neoplasm.

INTRODUCTION: Recent advances in chemotherapy and chemoradiotherapy (CRT) have enabled the use of conversion surgery in selected patients with initially unresectable pancreatic duct adenocarcinoma after a favorable response to preoperative treatment. However, conversion surgery for invasive intraductal papillary mucinous neoplasm (IPMN) has not been reported. CASE REPORT: A 63-year-old man was referred to our hospital for invasive IPMN treatment. Computed tomography revealed a multilocular tumor of 7.2 × 5.8 cm in diameter, which surrounded approximately 180° of the superior mesenteric artery and totally occluded the superior mesenteric vein (SMV). He was diagnosed with unresectable invasive IPMN. CRT was performed using four cycles of S-1 (100 mg/day) based on body surface area for 14 days every 3 weeks plus gemcitabine 1,000 mg/m2 on days 8 and 15 with concurrent radiotherapy (50.4 Gy in 28 fractions). Response to chemotherapy revealed partial response according to the Response Evaluation Criteria in Solid Tumors; subsequently, subtotal stomach-preserving pancreaticoduodenectomy with SMV resection was performed. The postoperative course was uneventful. Four courses of adjuvant chemotherapy with TS-1 100 mg / day were administered postoperatively. At 5 years and 9 months after initiating treatment, the patient was alive without recurrence.

[A Case of Long-Term Survival of a Patient with a Nodal Recurrence of Intrahepatic Cholangiocarcinoma Who Attained Complete Remission with S-1 Monotherapy].

An 82-year-old man was referred to our hospital after a hepatic tumor was identified on ultrasonography.Computed tomography(CT)revealed a hypovascular tumor measuring 3 cm in diameter in the lateral section.He was diagnosed as having intrahepatic cholangiocarcinoma(ICC), and a left hemihepatectomy was performed in November 2012. During the postoperative follow-up in August 2013, CT revealed swollen lymph nodes around the greater curvature of the stomach and upper edge of the pancreas.By using endoscopic ultrasonography fine-needle aspiration(EUS-FNA), lymph node metastases of the ICC was diagnosed.S -1 monotherapy was initiated instead of gemcitabine and cisplatin regimens because of renal dysfunction.In July 2014, CT revealed that both lymph nodes were shrinking, and in January 2015, S-1 administration was discontinued upon the patient's request.However, the patient survived for 4 years without S-1 administration, and no recurrent tumors were recognized on CT in November 2018.O ur diagnosis indicates complete remission.